Off the Mark

Drs. David Brody and Michael Serby mock psychoanalysis in their letter in the June 6 issue. Trying to explain the relevance of psychoanalysis to most psychiatrists is as difficult as explaining the relevance of Einstein’s theories to one schooled in Newtonian physics. The easy success of modern psychotropics and the facile yet unproven theories of neurochemistry lull many into the belief that there is no unconscious mental life. My personal analysis a quarter of a century ago not only inspired my interest in psychiatry at a time when the only antidepressants were the tricyclics, but also demonstrated that there was a subterranean mental world.

Today I would not recommend psychoanalysis to 99 percent of my patients in either the office or psychiatric hospital. Yet the tool of psychoanalytic thinking and the self-understanding it provides are as relevant as the prescription pad I carry. The fault is not with the patients or with the method because of the difficulty of submitting psychoanalysis to research scrutiny or validation. Many theories of modern physics were at first untestable because of limitations of technology. Therefore, regretfully, we fall back on “anecdotal reports,” which are perhaps the only scientific instrument so far with any power in psychoanalysis. Yet, this mode of testing is not recognized as useful in contrast to current double-blind, controlled methods that are used when we deal with limited variables in clinical trials.

Yet, even the seemingly rosy success of cognitive therapy confirmed by these current instruments is recently questioned because of ascertainment bias, not to mention other weaknesses in methodology. The closer we look at many psychiatric questions, the more confusing the issues become.